The mega tender for cancer and end-of-life care: Staffordshire in March 2015
Published: Thursday, 22 October 2015 14:38
Written by Una
Open Democracy Our NHS's Caroline Malloy has written "Leak reveals worrying truth behind the biggest NHS privatisation yet" (March 2015)".
The leaked proposals include handing all responsibility for commissioning cancer services for 800, sales 000 patients to a ‘prime provider’ - which can be a private company - who will then sub-contract services to companies of their choice, after an initial 2-year handover period. The first tranche of patients to be handed over to new companies will be breast, lung, bladder and prostate cancer, with others added later, we learn today.
The most worrying thing about the leaked plans is their lack of accountability or redress and their shocking vagueness.
The document sets out “The commissioners do not intend to specify in detail how outcomes should be achieved” preferring instead “the use of high level outcomes”. It sets out how the contract will be based on nine outcomes set out by Macmillan such as “I can enjoy life” and “I want to die well”.
During the first two years the main responsibility on the company will be to develop a more detailed set of ‘service outcomes’ - the criteria that they will be measured against for the remaining eight years.
This, Godfrey [Parliamentary Labour candidate Kate Godfrey] says, is a unique arrangement - deciding ‘most of elements of contract design’ such as performance standards and targets, after the contract has been awarded. The company writes its own rules, effectively, and decides what it will - and won't - do.
But there are clues. There is an emphasis on patients being expected to “self-manage at home”. There is talk of a “stable and managed change environment where providers of care know what is expected of them…this will require disinvestment for (some)”.
Experienced health campaigner John Lister of Health Emergency has described the arrangement as ‘no more than a blank cheque for whichever private firm is most ruthlessly willing to cut costs to shore up their own profits’.
And if the ‘prime provider’ company does fail the tests they have created for themselves, there does not appear to be any provision for a break clause for the NHS to get out of the contract. OurNHS understands that - on the basis of what is set out here - it would be legally very difficult if not impossible for the ‘prime provider’ to be sacked for failings which they could blame on their sub-contractors.
The shortlisted 'prime provider' bidders are all both controversial and well connected. They include United Health (through its subsidiary Optum), the former employer of new NHS boss Simon Stevens; Virgin Care (who have been warned about service standards by inspectors), CSC Computer Sciences (who were paid £12bn by the UK taxpayer for an IT project that failed to deliver anything that worked) and Interserve Investments (chaired by former Conservative policy chief Lord Blackwell).
Two NHS trusts are also shortlisted, those that currently run respectively Stafford and Stoke University Hospitals, and Wolverhampton hospital. But Godfrey has been advised that “this contract seems to have been designed expressly to exclude them” through clauses about financial arrangements “which seem to have been specifically written with a private company in mind”. There are also extensive clauses setting out competition requirements which appear to weigh most heavily on “current providers” (ie the NHS). This might explain why, when Valerie Vaz MP asked local health boss Andrew Donald (chair of Stafford CCG) “Just tell me, is the University hospital happy with this process?” he replied simply “No, the chief executive is not.”
What happens to the radiology department who are dealing with both cancer and non-cancer patients? What happens to the cancer patient who is being treated by the NHS for other conditions such as diabetes? What happens to patients who live on the geographical margins of the area? Does the contract even cover all patients in the area? To what extent will existing services be provided? What standards are expected to be met?
It seems these are treated as minor details to be worked out - after the £700m contract is awarded.